Let’s talk about something! It’s not a pleasant subject. It’s the nasty little triad of issues one might face after having a vaginal birth. I’m talking about the after effects and trauma that can happen to your bottom. It’s rarely discussed before a birth and I believe there is a reason for that. The physical injury to the pelvic floor area from a vaginal birth can cause significant damage that leads to some rather unpleasant, uncomfortable and down right painful issues some women have to face. I’m talking about hemorrhoids, fissures and tears that occur in the perineum during, for hemorrhoids, and after birth for all three. There are some things you need to know to help you deal with these uncomfortable issues if you find you have developed these.

HEMORRHOIDS

Let’s start with hemorrhoids!

Hemorrhoids are a swelling and inflammation of veins in or around the anus and lower part of the rectum. They can be painful and itchy. Hemorrhoids are very common in pregnancy as the increased weight from carrying the baby causes greater pressures on the pelvic floor. Also prenatal vitamins and hormones cause a slowing down of your colon and swelling of your veins, two factors contributing to constipation that can lead to hemorrhoids.

So to avoid hemorrhoids you’ll want to avoid constipation and the bearing down that usually goes along with it.

The first step is to avoid being constipated.

Diet has a huge implication on constipation. (Please consult a nutritionist for greater help with your diet) By eating more fiber rich foods you can help keep things moving in your colon. Raw veggies are a great way to increase fiber or adding flax seeds to your foods can help too. Be careful in adding too much fiber at first if things aren’t moving well especially if you aren’t doing this next thing.

That is, drinking enough water. Increasing your water intake, especially when you are breastfeeding, will bring more water to help keep things flowing through your colon. Moving your body will also do the same.

The next step it to use good toileting habits. When you sit on the toilet, you want to make sure you keep your back straight and lean forward. Avoid sitting slumped on the toilet. It can help to have your knees higher than your hips. There is the squotty potty chair you can purchase to help with this or you can use two yoga blocks, toilet paper rolls or a big fat can of tomatoes and put your feet upon.

To relax your pelvic floor you can try making different sounds to see which sound bulges your pelvic floor downward more easily. Take a deep breath and say “Grrr!” or “Shhhh” and see which one lengthens your pelvic floor. Use that sound during your next bowel movement to help move things down and out so your pelvic floor stays relaxed!

Once a hemorrhoid is in place you need to decrease any excess pressure on this tissue in order for it to heal. With all the bearing down that happens in birth the rectal tissues need to learn to come back up in and inside again. That can only happen when you avoid bearing down during a bowel movement after your birth. It’s important to allow your stool to pass on it’s own without you having to force it out. Any forcefulness will only exacerbate your hemorrhoids.

Also when dealing with hemorrhoids after birth, I find you also have to address the soft tissue in your vaginal and anal openings. We’ll cover how to do this later in this article.

Around the anal opening is a sphincter muscle. It’s very common for this muscle to have small “knots” in it from the birth, especially if you tore. These knots don’t allow the muscles to expand evenly to allow your stool to come out. When a hemorrhoid is present, most likely there is a restriction or “knot” in these tissues that can prevent the hemorrhoid from healing. They can also lead to an even greater problem and that is a fissure!

FISSURES

A fissure is a open tear inside the rectal tissues. Fissures have to be one of THE most painful conditions to recover from after birth. The problem with this condition is the tear has a hard time healing because it gets reopened every time you have a bowel movement. It makes having a bowel movement EXTREMELY painful! Some women, who have a fissure, report having chills, breaking out into a sweat and even their whole body shaking after having a bowel movement. The pain afterwards can last for hours. When dealing with a fissure for any length of time the anticipation of a bowel movement can bring fear and greater tightness to the pelvic floor area, which creates a vicious cycle that is hard to break. It’s no fun at all!

There is one thing that has helped my clients when dealing with a fissure and that is to massage their perineum and anal sphincter prior to a bowel movement. Usually there is increased tension in the anal sphincter that is on the opposite side of where the fissure lies. When you release this knot prior to a bowel movement it can lessen the pressures placed on the fissure and allow it to heal a little bit easier. Stay tuned to learn how to massage your anal sphincter area.

TEARING IN YOUR PERINEUM

The third issue that is closely related to hemorrhoids and fissures is tearing in your perineum. Unfortunately tearing from birth is very common for women. Scar tissue forms to help heal a tear. Scar tissue is not as flexible as normal tissue and restricts the tissue mobility in the area. This can inhibit a stools flow out the anal sphincter and contribute to the development and prevent the healing of hemorrhoids and fissures. Mobilizing this scar tissue can help soften the tissues and allow easier flow with less pressures, helping both issues heal.

Caring for your Perineum After Birth

So what’s a new mama to do to help her perineum after birth?

Massage this area!

What do you do? It’s simple!

Take your thumb pad and place it just inside your vaginal opening. Your knuckle should stay on the outside. Place your index finger on your anal sphincter. Start on one side as far as you can go and pinch the two fingers together and see if it feels soft and mushy or hard and resistant to compression. You want your tissues to be soft and supple. Work your way along toward the opposite side and see where the tissues are resistant to compression. Where there is resistance you can apply pressure by gently compressing the area between your fingers while breathing into the area at the same time. Hold this pressure until you feel the tissues soften and release.

Scar tissue can create thickening and resistance to mobility. Compression and pressure can help release this but sometimes scar tissue needs more. If you find scar tissue that is not releasing to pressure there can be an emotion stuck in there. Honoring that feeling and releasing whatever emotion is there is needed before it can let go. To read more about how scar tissue and emotions are connected check out this blog post.

Pinching between the anal opening and the vagina works on the upper half of the anal sphincter. For the lower part take your index finger and apply pressure around the sphincter from 3 to 9:00 if you think of it as a clock face. Check to see if you feel any spot more resistant than the others. If you do gently apply pressure with your finger in a downward motion and just hold it until you feel the spot release.

Massaging this area before every bowel movement can allow the tissues to expand more easily for your stool. This can help keep some of the excess pressure off your fissure area and potentially help it heal. Decreasing any resistant or thickened tissues helps to normalize the tissues so your stool flows through more easily.

There’s so much more to all of this that if you don’t find relief from doing the above, please go see a women’s health physical therapist or a holistic pelvic care specialist to get some help. You can find a practitioner near you by checking out these websites: MoveForwardPT.com or WildFeminine.com

Is Your Pelvis Still trying to Birth Your Baby?

Labor can be such an arduous task. Whether it’s really quick or lasts for days, the impact on the body is huge, especially for the pelvis. It doesn’t matter how long it takes to get the baby out, the pelvis can still be left in its open birthing position. It can remain this way for months to many years.

I first identified this issue in my aunt who had a very traumatic birth with her first son who was 47 years old at the time I found this. Her pelvis was still open from birthing. When I realized what was going on I started looking for it other women who came to see me and was surprised how often I found it.

How do I know if a pelvis is still birthing?

I’m able to feel what the energy of the bones and tissues want to do. I listen to the body and see what wants to happen. No matter what part of the body, an ankle sprain, I can tell you how you twisted your ankle, an injury to your shoulder, leg or pelvis, your body holds onto the energy of the injury. It’s in the tissues and remains there and your body has to work around it. It’s usually not a big deal except most of the time we keep reinjuring it, in the same way. That could because the energy of the injury remains in the tissues until we release it. It could also be why some injuries just never seem to fully heal.

Birthing Pattern in the Pelvis

Pelvic Motions during pushing phase of birth

It’s the same thing with birth and the pelvis. When the pelvis births a baby, the sacrum pivots and in the pushing phase the tailbone moves backwards and the sit bones, or ischiums splay out to the side to get wider. Usually this is the position that most women get stuck in because they tend to have a trauma response in their body from the intensity of the labor. Pushing too long or the baby coming through too quickly can create a shock effect in the tissues and they get stuck in this open birthing position.

I’ve been asking these women whose pelvis’ are still birthing what they are experiencing and the effects have been from severe to subtle. The most common complaint was a sense of feeling ungrounded. Some complained of not being able to sit comfortably or evenly on their buttock. Others had more subtle complaints of feeling spacey, just not the same, or feeling weird when walking. One of the bigger issues women can have from this is painful intercourse and an inability to contract their pelvic floor muscles.

Since all of the pelvic floor muscles attach to the bones of the pelvis, having the bones widened puts a stretch on these muscles. A stretched out muscle doesn’t have the same contraction ability and will appear weak. These lengthened muscles also don’t have the give or flexibility they need in order to allow penetration to happen with intercourse. My aunt I mentioned earlier has very little to almost no contraction of her pelvic floor muscles. Another client I saw was still in a birthing pattern and she was having pain with penetration. After one session of bringing her ischiums back together, her pelvic floor muscles relaxed and she had no more pain!

So what do I do?

It’s a shame that the main treatment for weakened pelvic floor muscles is to see a women’s health physical therapists, yet most of them don’t know how to assess or treat a pelvis stuck in the birthing position. No amount of kegels or biofeedback is going to help you get a strained, traumatized muscle stronger until it gets some help. It’s amazing how instantaneously a muscle can respond and contract when it’s not being lengthened or in a state of shock from the birth.

Most chiropractors don’t know about this stuck birthing pelvis and your doctor will most likely look at you weird if you bring this to their attention. They all are just dealing with the physical tissues that when you look at the tissues everything appears just fine. They aren’t aware of and don’t know how to address the energetics, emotions or trauma that get so tied up into the tissues keeping them held in this birthing pattern. You have to address them all in order for the tissues to release and the pelvis to return to it’s normal pre-birth state.

I have found in working with women that we need to address ALL of the trauma or issues that occurred during the birth so the pelvis can return to it’s birthing position after a treatment. The sooner after the birth one comes in the better. It’s easier to release the birth pattern because it hasn’t been stuck in the body for a length of time for it to think it’s the new normal position to stay in. However no matter how long it’s been you can still release the bones and tissues so they can find their natural place. It’s just takes a bit longer.

When you think of having sex, what’s your initial reaction? Is it one of fun, pleasure, and enjoyment? For many women it’s not. In fact it’s down right painful. Their response is one of fear, pain and simple avoidance. It’s sad that some women are not interested in ever having sex again. It doesn’t need to be this way.

I”ve seen so many women in my practice who have gone to multiple doctors who all look at their vagina’s and say, “well, it looks normal in here. There’s nothing wrong, must be all in your head, try a little bit more wine beforehand!” And for most women suffering from pain with sex, all the wine in the world won’t help their situation.

What most doctor’s aren’t trained in looking at is the mobility of the tissues. How can the vaginal, or pelvic floor muscles move and stretch? They aren’t pressing around in there to find out. So when they look at the tissues, it all looks normal and healthy. Yet if they were to just press on the sides of your vaginal opening they would most likely find brick walls or tissues that don’t have the ability to expand or stretch. We need our vaginal tissues to be able to move up and down and expand out in a circle in order to enjoy intercourse without pain.

There are two types of pain with intercourse, insertional pain and deep thrusting pain. Insertional pain is a problem with the pelvic floor muscles being able to expand and stretch open to allow the penis to enter. Deep thrusting pain is an inability of the vaginal tissues to move up and down. The uterus or bladder may be inhibited from moving upwards so every deep thrust is like hitting a brick wall, creating pain. Both of these issues can be healed by seeing a women’s health physical therapist.

Some common issues that can create painful intercourse for insertional pain are falls on your tailbone and buttocks, childbirth, and trauma from abuse whether physical or emotional. Impact injuries to the tailbone area cause the muscles to tighten up to protect the area not allowing them to relax and stretch. Any tearing to the pelvic floor area during childbirth creates scar tissue making the area less mobile. Also I find many women’s pelvis are still in a childbirth position with their sit bones still splaying out to the side putting stretch on the pelvic floor tissues. Helping them to come back together again relieves the strain on the tissues. Emotional or physical abuse creates a subconscious tightening of the pelvic floor area. Helping women reconnect and reclaim this area and feel safe again can help the muscles release this held tension.

C-section or any lower abdominal surgical scars or car accidents usually cause deep thrusting pains. Scar tissue prevents the organs from moving up and down and creates a wall between the tissues. Every time there is deep thrusting that hits this block, pain is created. Massaging your lower abdomen and making sure your tissues can move freely upwards and side to side should help alleviate this pain. I have a video on my website, How to Massage Your C-Section Scar that you can view for free. It doesn’t matter how long it’s been since your surgery you can always get more mobility in the tissues with massage.

Please help spread the word to women so they know there is help for them in this area. It really saddens me that women are not able to enjoy themselves fully. A women’s health physical therapist can help you with this issue. For the most part, I just need to see someone one time and they are back to enjoying intercourse again freely without pain. Reach out, get help and enjoy sex again! Good luck!

Is your baby due in a couple of weeks and he’s not engaging into your pelvis? Feeling your baby should be dropping down into your pelvis a little more than he is?

There is one major thing you need to check to see if it is what is stopping your baby from coming on down.

CHECK OUT YOUR PELVIC FLOOR MUSCLES

I encourage every woman, about to give birth, to assess her pelvic floor muscle tone. (Actually every woman should check their pelvic floor muscle tone, whether you are having a baby or not!) This is more than just perineal massage. This is about making sure your pelvic floor muscles have the ability to release and stretch. When doing your perineal massage, you need to make sure your pelvic floor muscles have spring to them. They should give and release like when you push down on a trampoline, it gives way and then comes back up.
Imagine the opening of your vagina is a clock you are facing. At 12:00 is the urethra and clitoris and a 6:00 is the perineal body, junction between the anus and the vaginal opening. From 3 to 6 :00 and from 6 to 9:00 are your muscles. If you push down and out to the side at a diagonal you will see whether your muscles give or not. They should give easily to your pressure and spring back up when you release.

PELVIC FLOOR MUSCLES AS STOP LIGHT FOR BABY

I liken the pelvic floor muscles to a stop light, signaling the baby on what to do. If you have too much tone in them, as in red light tone, that’s telling the baby to not come down this way. Red light tone is where the muscles have zero deformability to them. You press on them and they are bricks and don’t budge. This may be caused by a passive tension in the muscles from our unconscious holding or clenching of these muscles from an injury. Actively we can clench these muscles if we want to stop gas from passing. The problem is so many women are walking around with tension in these muscles and they don’t even know it.

Have you ever caught yourself with your shoulders up by your ears and once you were aware of it you were able to relax them back down. That same kind of tension can be found in our pelvic floor muscles. The only difference is we don’t have the visual cue of our shoulders to let us know the tension is there. But we do know what is there if we assess the pelvic floor muscles. When you find increased tension in the muscles, and it can be one side or both sides, simply put a gentle pressure on the muscle and breathe down into it. With awareness, passively held tension can release. If it’s resistant to release you may need some help from a Women’s Health physical therapist.

Red light tone can also be caused from a fall on the tailbone that happened anytime in your life. Having the tailbone offset can create tension in the muscles keeping it in that position. Getting your tailbone back into alignment is not something you can do on your own. I haven’t found a way yet to help someone do this to herself so again seeing a women’s health PT can be very helpful. (You can find a WHPT near you at www.MoveForwardPT.com)

I’ve seen a couple of women come in with a baby’s head off to one side, heading into the hip, instead of the pelvic inlet. In evaluating their pelvic floor muscles the opposite side pelvic floor muscles had increased tone, like it was repelling the baby’s head from that side. As soon as those muscles released the baby’s head shifted to midline. In one case the baby’s positioning change was so dramatically I wished I had taken before and after pictures of her belly.

Yellow light tone in the pelvic floor muscles, means there is some tension and resistance to the tissues to being stretched but it can do it a little bit. Yellow light tone just means the baby will have a little bit more resistance coming through. If you work with this tension you should be able to let go and get your tissues into a green light state.

Green light tone in your pelvic floor muscles is the go for it signal for the baby to come on through! This is the kind of tone in the muscles you want with no tension in them at all. You press on them and they spring and stretch easily and pop right back up when you release that pressure. Babies love green light tone in the muscles!

So what kind of tone are you carrying around in your pelvic floor? Assess yourself and find out now, before you go into labor. If you do find tension in the muscles work with them to see if you can release it. You’ll be so glad you did and your baby will be too!

Being a Women’s Health Physical Therapist has given me the privilege of working with a lot of post partum women. I have a profound respect for the body’s ability to birth a baby. It is a natural event that the body is designed to perform.

While birth is a natural function of the body, it is not designed to handle the effects of prolonged pushing or a baby that comes out in a less than ideal way. These conditions place excessive strain on the pelvis and vaginal tissues and create issues. Issues that a woman doesn’t have to just deal with for the rest of her life, but can get help with and fully recover. That is, when she gets help. Often times women are left to just deal with theses issues on their own and learn to just live with them. Many are convinced or made to believe it’s just a natural side effect of childbirth. But it doesn’t have to be this way!

A large majority of issues such as painful intercourse, incontinence, a pressure or falling out feeling in the vaginal area from organ prolapse, or just your body not feeling the same anymore, can all be helped by working with a women’s health physical therapist.

Helping Women Get the Help they Need!

Birthing professionals need to understand the effects a birth can have on a woman’s body and help them get the support they need to help their pelvis come back to it’s normal alignment and get their vaginal tissues released. This idea that birth is a natural function and we just spring right back to our pre-pregnancy state doesn’t always happen for all birthing women. The birthing professional needs to listen to the post partum woman and help them to understand that what they are experiencing in their body is an effect of birth and there is help.

Also understanding that when a birthing woman gets to a point in her labor where she feels like she doesn’t want to go on, it’s too much, or “just get this baby out of me now!” are all signs where the body can register the event as traumatic. When trauma occurs the tissues get stuck in the position she is in during the traumatic moment. The woman may not vocally say these words, it may just be a fleeting thought but those tissues respond accordingly. After the birth is over when you are reviewing the birth with the new mama, asking her if she got to that point of wanting things to stop or be done could give you an idea if any trauma effects may have occurred.

Releasing Trauma in the Body

When we experience any traumatic event our body has three different options to protect itself. We can either choose to fight the event, try and flight from it or we just freeze. During labor, fighting and running away are not an option. The body’s only choice is to freeze, so the tissues get stuck in whatever position they are in at the time.

Usually this occurs during the pushing phase. When women are pushing their ischiums, or sit bones, are splayed out to the side, their sacrum is nutated, where the tailbone is farther away from the pubic bone, and their tissues are bearing down. A traumatic response can keep these tissues in this position well after the birth is over.

By listening to the tissues on an energetic level, one can feel what they still want to do. Helping a new mom tune into the effected area and realize that the birth is over can bring the tissues into a more neutral state.

When I assess post partum women’s tissues on an energetic level, many of them present with their bladder and uterine tissues still bearing down as if they are continuing to push a baby out. By just placing my index finger on the urethra and bladder and just listening to what that tissue wants to do, most of the time my finger gets pushed out of the vagina.

The great thing is, it’s easy to fix this problem. By having the woman bring her attention to the tissues I’m touching she can help them to realize the birth is over, that the tissues can stay up and inside. The tissues retract back up and in like a turtle pulling its head back into its shell.

Bringing the ischiums back into midline also helps to relax the pelvic floor tissues. Since the pelvic floor muscles attach to the sides of the ischiums, when they are splayed out and stuck there, the pelvic floor muscles can have too much stretch on them not allowing them to relax and contract fully. Sometimes one ischium gets more pressure than the other, creating an imbalance in the pelvis, especially when sitting. To learn more about pelvic trauma in birth, read this blog.

The vaginal tissues may need help releasing the effects of the baby turning it’s head to come out. Many times I can still feel the twisting effect on the pelvic floor tissues from this part of the birth. Soft tissue mobilization of the vaginal tissues can help restore normal function and contraction ability of the pelvic floor muscles. Read more here. Without this type of work regaining strength in the pelvic floor muscles can be like beating your head against a wall. The muscles need to be released in order to work properly. But in order to free up these tissues, any trauma that may be present in the tissues needs to be released first.

I had one mom I worked with who had seen another women’s health physical therapist for 12 sessions and she reported that after every internal session of massage with this PT, her pelvic floor area would ache and hurt afterwards. This is a sign that there is trauma in the tissues. When a tissue with tension in it doesn’t want to let go or release, there is trauma that needs to be addressed first. Also when a tissue reacts by hurting worse after a session, the body is trying to tell you it does not like that approach, something else needs to happen first. By listening to the tissues and sensing them you can tell when they are willing or unwilling to release. There is a different quality to the tissues when trauma is present.

Working with trauma in the tissues can be challenging, depending on the amount of trauma one has experienced. A lot of times with birth, just the act of bringing a woman’s awareness to the tissues, helping her breathe down into the affected area can help them to release. Also helping her go back to remembering herself before the moment of trauma and reconnecting to herself then can help release the tension and trauma in the tissues. This work needs to be extremely gentle and respectful. Forcing any tissues in the vaginal area is very counterproductive.

Helping new moms recover from the effects of birth needs to be a bigger priority in our country. In France, women get 8 physical therapy visits after giving birth. Getting moms the support and help they need to heal from the effects of trauma from birth and get their body and tissues back into their proper place should be available for every woman who has had a baby. I wish I could see every post partum woman just once to get her on the path to reclaiming her body and healing after birth.

Sacroiliac Joint Dysfunction- Part 2

If your low back pain is caused by your sacroiliac joint dysfunction and isn’t responding to traditional treatment there are two areas that you need to check out.

In the first part of this post we talked about how lower abdominal scar tissue may be inhibiting your sacrum. Lack of mobility in the sacrum can cause dysfunction in the sacroiliac joint.

Another area you should have checked out is your pelvic floor muscles. Since your pelvic floor muscles are attached to the sacrum, if there is increased tone in them, they can restrict sacral mobility as well. When a muscles has increased tone, it has limited flexibility. The sacrum needs to be able to move forwards and backwards as you bend and straighten. If it gets anchored by tightness in the pelvic floor muscles it’s not going to be able to move as it should and can cause dysfunction in the sacroiliac joint.

I’ve had many clients come to see me with low back pain. In assessing their pelvis there was limited mobility in one side of their sacroiliac joints. When I assessed their pelvic floor muscles, doing an internal exam, I found increased tone on the same time as the sacroiliac joint dysfunction.

There is a way for you to assess your own pelvic floor muscles. Get into a comfortable position leaning up against the headboard of your bed with your knees slightly bent out to the side. If you were to think of your vaginal opening as a clock face (with the clock facing out between your legs) your pelvic floor muscles run from 3 o’clock ( on the left side) to 9 o’clock (on your right side). Insert one of your thumbs into your vagina. Using your left thumb press into the tissues from 9 to 6 o’clock and use your right thumb to check the tissues from 6 to 3 o’clock and see if both sides spring and move equally. Normal tissue has a nice bounce to it. A knot in the tissue will feel hard and have less mobility than the other side. The problem with doing this yourself is you have limited reach with your fingers. Your thumbs only reach so far and the muscles that could be a problem may be beyond your reach. When you encounter a hard area allow your thumb to sink into the tissue, you are not pushing your thumb in. Just allow it to sink into the tissue until it can’t sink in any further and just hold it there. As you hold it you are waiting for it to release or “melt” under your finger. You can try placing your other hand either on your pubic bone, your tailbone or on the same side ischium (your sit bone). Visualize a connection between your two hands and see if the placement of your other hand helps the tissue under your thumb relax. Your goal is to get the harder side tissue to feel the same as the other side. You can also try to massage the pelvic floor muscles between your thumb on the inside and your fingers on the outside. Sometime offering compression between your thumb and fingers can help the tissues to relax.

Doing this self message can help rebalance your pelvic floor muscles and free up your sacrum so your sacroiliac joint can move as it needs to. Getting mobility back into your sacroiliac joint can end your low back pain. If you are not able to get the tissues to soften on your own I encourage you to find a women’s health physical therapist in your area to help you out. Go to www.MoveForwardPT.com and search under women’s health PT’s to find one near you. Internal vaginal work can do a lot of good for not only low back pain but for painful intercourse as well.